ON THE 
PHYSIOLOGY 
OF 
SYPHILITIC INFECTION, 
AS APPLIED TO THE 
SUCCESSIVE MANIFESTATIONS OF THE DISEASE. 
BY 
FESSENDEN N. OTIS, M. D., 
CLINICAL PROFESSOR OF VENEREAL DISEASES AT THE COLLEGE OF PHYSICIANS AND 
SURGEONS, NEW YORK ; SURGEON TO THE DEPARTMENT OF GENITO-URINARY AND 
CUTANEOUS DISEASES IN THE STRANGERS’ HOSPITAL, NEW YORK ; FELLOW 
OF THE NEW YORK ACADEMY OF MEDICINE; MEMBER OF THE N. Y. 
COUNTY MEDICAL SOCIETY, OF THE N. Y. PATHOLOGICAL 
SOCIETY, OF THE N. Y. DERMATOLOGICAL SOCIETY, 
OF THE N. Y. MEDICAL AND SURGICAL 
SOCIETY, ETC., ETC. 
PART SECOND. 
{REPHINTED FROM THE N. 7. MEDICAL JOURNAL, JULY, 1872.] 
NEW YORK: 
D. APPLETON & COMPANY, 
54 9 & 551 BROADWAY. 
18Y2. AD VER TIS EMES 'i 6. 
NEW MEDICAL WORKS IN Ell ESS. 
I. 
A TREATISE 
ON 
OVARIAN TUMORS, 
THEIE PATHOLOGY, DIAGNOSIS, AND TREATMENT, 
■WITH REFERENCE especially to 
OYAEIOTOMY. 
By E. R. PEASLEE, M. D., LL. D., 
Professor of Diseases of Women in Dartmoutli College; one of the Consulting 
Surgeons to the N. Y. State Woman’s Hospital; formerly Pro- 
fessor of Obstetrics and Diseases of Women in the 
N. Y. Medical College; Corresponding Mem- 
ber of the Obstetrical Society of 
Berlin, etc., etc., etc. 
II. 
On Puerperal Diseases. 
CLINICAL LECTURES DELIVERED AT BELLEVUE HOSPITAL. 
By Fordyce Barker, M. D., Clinical Professor of Midwifery and Diseases of 
Women, in the Bellevue Hospital Medical College; Obstetric Physician to Belle- 
vue Hospital; Consulting Physician to the New York State Woman’s Hospital, 
and to the New York State Hospital for Diseases of the Nervous System; Hon- 
orary Member of the Edinburgh Obstetrical Society, etc., etc. 
III. 
A Treatise on Diseases of the Bones. 
«y Thomas M. Markoe, M. D., Professor of Surgery in the College of Physicians 
and Surgeons, New York, etc., etc. 
IV. 
ON THE 
Treatment of Pulmonary Consumption, 
BY HYGIENE, CLIMATE, AND MEDICINE. 
By JAMES IIENRY BENNET, M. D. 
SECOND EDITION, REVISED AND ENLARGED. 
D. APPLETON & CO., Publishers, 
549 & 551 BROADWAY. NEW YORK. ON THE 
PHYSIOLOGY 
OF 
SYPHILITIC INFECTION, 
AS APPLIED TO THE 
SUCCESSIVE MANIFESTATIONS OF THE DISEASE. 
BY \J 
FESSENDEN N. OTIS, M. D., 
CLINICAL PROFESSOR OF VENEREAL DISEASES AT THE COLLEGE OF PHYSICIANS AND 
SURGEONS, NEW YORK ; SURGEON TO THE DEPARTMENT OF GENITO-URINARY AND 
CUTANEOUS DISEASES IN THE STRANGERS’ HOSPITAL, NEW YORK ; FELLOW 
OF THE NEW YORK ACADEMY OF MEDICINE; MEMBER OF THE N. Y. 
COUNTY MEDICAL SOCIETY, OF THE N. Y. PATHOLOGICAL 
SOCIETY, OF THE N. Y. DERMATOLOGICAL SOCIETY, 
OF THE N. Y. MEDICAL AND SURGICAL 
SOCIETY, ETC.. ETC. 
PART SECOND. 
[REPRINTED FROM THE NEW YORK MEDICAL JOURNAL, JULY, 1872.] 
NEW YORK: 
D. APPLETON AND COMPANY, 
649 & 651 BROADWAY. 
1872. ON THE PHYSIOLOGY OF SYPHILITIC INFEC- 
TION, AS APPLIED TO THE SUCCESSIVE 
MANIFESTATIONS OF THE DISEASE.1 
On a previous occasion I had the honor of reading a paper 
before this Society entitled “ The Physiology of Syphilitic In- 
fection.” In this paper it was claimed that the infection took 
place through the agency of the lymphatic system alone ; 
that it was the germinal matter of the tissue-fluids and of 
the blood—the unformed material—the white corpuscular 
element alone, that was capable of entering into combination 
with the abnormal germinal cells in which the syphilitic in- 
fluence was supposed to reside. These abnormal cells or dis- 
ease-germs were assumed to be analogous to the disease-germs 
discovered by Beale and Chauveau in the blood of animals 
diseased by the cattle-plague, and in the fluid of tlie vaccine 
virus—germinal corpuscles, probably originating in the hu- 
man organism, but possessing, besides the properties and pow- 
ers of the white blood-corpuscle, a peculiar tenacity of exist- 
ence, a capacity to grow 'and multiply when removed from 
the seat of their development and transferred to another situa- 
tion, provided only that they were supplied with sufficient 
nutrient pabulum. It was further claimed that, through the 
current of the tissue-fluids which moves constantly toward the 
lymphatic vessels, such disease-germs, deposited upon an 
abraded cutaneous surface, would necessarily be drawn tow- 
ard, and might finally effect an entrance into, the underlying 
1 Read before the County Medical Society, May 27, 1872. 4 
PHYSIOLOGY OP SYPHILITIC INFECTION. 
lymphatic vessels of the part. It was also shown that, as the 
influence of such disease-germs would be to induce a coagula- 
tion of the tissue-fluids, such coagulation would of necessity 
delay the transit of the disease-germ from the surface of inocu- 
lation to and into the lymphatic vessels, and that this delay 
favored the proliferation of the disease-germs; that the 
fibrinization of the tissue-lymph and the increased develop- 
ment of the connective-tissue cells at the point of inoculation 
would thus be effected to an extent sufficient to produce the 
induration which is looked upon as a characteristic of the 
initial lesion of syphilis. It was then claimed that the so- 
called period of incubation of syphilis corresponded to the 
time required for the disease-germ or its descendants to ac- 
complish the transit from the inoculation-surface to and into 
the interior of the underlying lymphatic capillary; and that, af- 
ter having effected an entrance into the lymphatic vessel, it 
passed directly along this canal until it was arrested by the 
lymphatic gland with which it was in connection. 
Half a year subsequent to the publication of the foregoing 
views in the New York Medical Gazette, and in the Amer- 
ican Journal of Syphilography and Dermatology (July, 1871), 
it was announced at a meeting of the Medical Society of Vi- 
enna, January, 1872, that Dr. Lostorfer, of that city, after re- 
searches and experiments in the laboratory of Prof. Strieker, 
and in the syphilitic wards of Prof. Zeissl, covering a period 
of several months, had finally discovered and demonstrated 
the existence of the living syphilitic corpuscle or disease- 
germ, and its presence in the blood of persons affected with 
syphilis. This corpuscle was described as living bioplast, 
growing and multiplying after having been removed from the 
seat of its development; in short, corresponding most complete- 
ly with the disease-germ which I had assumed as the infecting 
agent in syphilis. Out of about fifty specimens of healthy 
and diseased blood, marked and numbered, and presented to 
Dr. Lostorfer by Profs. Hebra and Strieker, twenty were se- 
lected as containing the syphilitic corpuscle, and, by reference 
to marks and numbers, in every instance it was found that 
the specimens had been taken from persons affected with PHYSIOLOGY OF SYPHILITIC INFECTION. 
5 
syphilitic disease. The conditions under which this corpuscle 
was found, and the manner of its development, were so in 
harmony with the probabilities of such a discovery, that, with 
the corroboration thus afforded by Dr. Lostorfer, the syphilitic 
corpuscle was publicly accepted and confirmed by Profs. Skoda, 
Strieker, and Hebra. It was, however, soon after disputed 
by Profs. Wedl, Gruber, and Neumann, although no espe- 
cial investigation of the subject appears to have been made 
by these gentlemen. Prof. Strieker, however, at once com- 
menced a series of independent observations, for the purpose 
of ascertaining the validity and real significance of Dr. Los- 
torfer’s discovery. Advices received from Prof. Bumstead, by 
the last steamer, are to the effect that the corpuscle described 
by Dr. Lostorfer was actually found by him in syphilitic 
blood, but it was also found to have been present in the blood 
of persons not syphilitic, but who were the subject of cachexia 
from other causes. He then concludes that the corpuscle of 
Lostorfer is a product of the cachectic condition from any 
cause. The significance of this cachexia-corpuscle, when 
present, has not yet been ascertained. 
Had the discovery of Dr. Lostorfer’s corpuscle and its 
exclusive association with syphilis been confirmed, it must 
have been accepted as a corroboration of the views I have ad- 
vanced. It has, however, proved otherwise, and yet I claim, 
as confidently as before, that the necessity for such a corpuscle 
still exists, and that a present failure to demonstrate its actual 
presence in the blood of syphilitics does not militate against 
its acceptance as a reasonable and probable initiative point in 
the attempted elucidation of the acknowledged mysteries of 
syphilitic disease. 
I propose to-night to resume the subject of syphilitic in- 
fection at the point which is recognized as the termination 
of the first incubation of syphilis, and to consider the disease- 
germ, in its passage through the lymphatic glands adjacent 
to the surface of inoculation, in its relation to a second period 
of rest which is known to elapse between the induration of 
the initial lesion and the earliest period at which the con- 
stitutional manifestation of the disease ever takes place, a 6 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
period termed, by some authors, the second incubation of syph- 
ilis. 
It is a universally-accepted clinical fact in the natural his- 
tory of syphilis that a distinct period of rest succeeds the 
appearance of the initial lesion or chancre; that, for a time, 
the chancre is the only recognizable evidence of syphilis in 
the individual bearing it. That by no external sign or inter- 
nal sensation is it possible to discover any variation in the 
normal physiological processes of such subject that can be at- 
tributed to the influence of syphilitic disease. It is, however, 
claimed, and by a very great weight of authority, notwith- 
standing the complete absence of proof, that the development 
of the disease is steadily and surely progressing in the blood, 
and that it will finally acquire and exercise the power of pro- 
ducing general manifestations of the disease; and hence it is 
claimed that this period of apparent rest is an incubation as 
actual and complete as that which is known to elapse be- 
tween the date of vicious contact and the appearance of the 
initial lesion or chancre. 
According to authorities, the earliest and most common 
general manifestation of syphilis is a roseolous eruption. 
Accepting the occurrence of this exanthema as the termi- 
nation of the second period of incubation, Bicord places its 
accession at three weeks from the appearance of the chancre 
as the earliest, and at six months as the latest date at which 
he has ever known it to occur. Cullerier makes a similar 
statement. Lancereaux places it at from six weeks to two 
months, Sigmund from four to six weeks, Henry Lee from 
four to eight. Zeissl has never seen this eruption before 
the eighth week after contagion. Berkeley Hill confirms 
this experience, and further states that the longest interval 
he had observed was fifteen weeks. Diday cites fifty-two 
cases carefully observed, where the appearance of the chan- 
cre was ascertained, and where no treatment was resorted to, 
where the interval varied from twenty-five to a hundred and 
five days. Fournier, from an examination of three hundred 
and seven cases, concludes that this eruption, “ the earliest 
general manifestation of the disease,” appears from the for- PHYSIOLOGY OF SYPHILITIC INFECTION. 
7 
tieth to the fiftieth day after the development of the chancre. 
Puclie and Cullerier the younger state that roseola is never 
wholly absent in syphilis, and concur in the previous state- 
ment as to the date of its appearance. Bumstead regards 
the occurrence of the syphilitic roseola between the for- 
tieth and fiftieth day after the development of the chancre 
as almost certain, and states that he has never seen a case, 
carefully observed, where it had failed to show itself within 
three months. 
Thus it appears that, with great unanimity, authorities 
agree upon a period of rest, following the appearance of the 
initial lesion or chancre, of at least three or four weeks. Ab- 
sent in none, it is shown to have been prolonged in excep- 
tional cases to three or four months. Yirchow, in his “ Cel- 
lular Pathology,” p. 221, has furnished a parallel to this ap- 
parent cessation of progress in the early stages of syphilis, by 
showing what is known to occur in cases of mammary cancer, 
where, during a long period, only the axillary gland becomes 
implicated, the groups of glands next in succession, as well 
as all other organs, remaining free from disease. “We can 
account for this,” he remarks, “ upon no other supposition 
than that the gland collects the hurtful ingredients absorbed 
from the breast, and thereby, for a time, affords protection to 
the body; but at length proves insufficient, nay, perhaps, at 
a later period, itself becomes a new source of independent in- 
fection to the body, inasmuch as a further propagation of the 
poisonous matter may take place from the diseased parts of 
the gland.” I have, however, yet to find this view of Yir- 
chow’s accepted, by any of the numerous writers on syphilis, 
as applicable to the interval of rest following the appearance 
of the initial lesiop. The explanation of this remarkable phe- 
nomenon, given and generally accepted, is, that the disease has 
an inherent cyclical tendency—proceeding throughout its 
course by successive stages or bursts; that, notwithstanding 
the apparent rest, the vitiation of the circulatory fluids is 
going steadily, relentlessly on ; and that, wdien the system be- 
comes fully charged, an outbreak takes place, and is recog- 
nized in the syphilitic roseola. Thus a mystery, wholly in- 8 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
compatible with known physiological and pathological facts, 
is quietly accepted, almost without comment, and designated 
the second period of incubation. 
A certain and positive value must attach to a theory 
which shall even plausibly account for and explain a mys- 
tery. A point cVappui is thus fixed, about which the results 
of observation and investigation may crystallize—it is a step 
out of the unknown toward exact science. 
In the case of the first incubation of syphilis, clinical cases 
were adduced, supporting the theory of a gradual local de- 
velopment ot the influence of the disease-germ, up to the 
point of its final entrance into a lymphatic vessel. It was 
then shown that, through natural physiological processes, the 
disease-germ or its descendants would be carried along the 
lumen of the lymphatic canal until it reached the lymphatic 
gland in connection with that vessel, and that the arrest of 
the vitiated corpuscle in the substance of the gland was in 
accordance with the previously ascertained influence of the 
so-called syphilitic virus, viz., to induce a coagulation of the 
tissue-fluids with which it was brought in contact. 
The anatomical arrangement of the lymphatic glands has 
long been a point of inquiry. By early observers considered 
as consisting simply of coils of lymphatic vessels, they wrere 
demonstrated by Kolliker to possess a parenchyma in which 
the afferent vessels were wholly lost, and out of which the 
efferent vessels constituted themselves at the opposite side 
of the gland. This view, confirmed by Yirchow, was gener- 
ally accepted by histologists until within the last two years, 
since when, through the investigations of His, Frey, and 
Teichmann, and substantiated by Recklinghausen, it has been 
shown, that the circulation through the glands is continu- 
ous by the presence of lymph-paths lined with epithelium 
throughout the supposed parenchyma, and that consequently 
a continuous lymph-current through the substance of the 
glands could be demonstrated. 
Accepting this view, we have, then, as in the application 
of the disease-germ to the original abraded surface of a syphi- 
litic inoculation, the same two distinct forces by which the PHYSIOLOGY OF SYPHILITIC INFECTION. 
9 
progress of the vitiated corpuscle through the tissues of the 
lymphatic gland would be facilitated, viz., the independent 
power of amoeboid movement of the corpuscle, and the force 
of the lymph-current through the substance of the gland. 
Delayed in its progress by the same cause which produced 
the interval of* apparent rest occurring between the applica- 
tion of the virus to the surface of inoculation, and its arrival 
at the portals of the lymphatic gland of connection, corre- 
sponding to the period of first incubation, the coagulation 
of the lymph, effected by the presence of the disease-germ, 
may be accepted as producing a similar retardation in its 
passage through the substance of the lymphatic gland in con- 
nection, and thus reasonably explain the period of rest known 
as the second incubation of syphilis. 
As a result of the coagulating influence of the disease- 
germs or their descendants, in the lymph-paths traversing the 
lymphatic glands, we have, then, an arrest more or less com- 
plete of the lymph-current. The natural result of this would 
be an increased proliferation of the lymph-corpuscles both 
normal and vitiated, and their rapid accumulation within the 
gland, and we should expect to find following such occur- 
rences an immediate enlargement of the substance of the 
glands. This is exactly what we do find in every case : a de- 
velopment, a condensation of the normal constituents of the 
gland, a simple hyperplasia, which is always sluggish and non- 
inflammatory, and is recognized as characteristic of syphilis. 
We must also have, to a greater or less extent, and from the 
same causes, the same retardation of the vitiated corpuscles 
on their passage through the lymph-vessels and glands, which 
still interpose between the glands of original implication and 
the thoracic duct, through which they finally effect their en- 
trance into the general circulation. As an evidence that this 
is the course and influence of the disease-germs, after their 
passing through the first order of glands, we have a sudden 
increase in size of the glands of the second order—glands re- 
mote from the point of inoculation, the cervical, the submax- 
illary, the epitrochlear, etc., the slight but well-marked in- 
crease of temperature, a marked increase of the white corpus- 10 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
cular element of the blood, and various other evidences that 
the constitution at large is in embarrassment and distress in 
the performance of its normal nutritive and nervous func- 
tions. Prominent among these stands the roseolous eruption 
of this period, which is claimed to mark the termination of 
the second period of rest or incubation, and to usher in the 
active secondary or constitutional stage of syphilis. 
The period of so-called second incubation, then, whether 
caused by a necessity in the nature of the syphilitic virus, 
requiring a certain accumulation in the blood before general 
constitutional disturbances can take place, or caused by the 
gradual passage of the vitiated germinal matter through the 
glands and vessels of the lymphatic system, intervening be- 
tween the point of inoculation and the general circulation, is 
nevertheless an admitted fact, and the roseola is accepted as 
marking its termination. 
Let us inquire into the significance of this roseola. Is it 
really the result of pathological changes, necessarily depend- 
ent upon the syphilitic influence ? Or may we not be able to 
class it among the physiological phenomena, and thus show 
that it is not due to an elimination or an attempted elimina- 
tion of syphilitic material from the infected organism. 
Mr. Wilson, the distinguished English dermatologist and 
syphilograplier, gives the following description of this exan- 
them : “ Koseola syphilitica commonly presents itself in the 
form of undefined patches, giving to the skin an appearance 
identical with that of common idiopathic roseola or measles, 
and is due, like the two latter, to the manner of distribution 
of the blood-vessels of the skin. Perhaps,” Ite says, “ the 
congested patch represents the ramifications of a single ar- 
terial trunk ; perhaps it embraces that small capillary system 
which is normally emptied by a separate venous trunk; per- 
haps, again, it includes the small district of skin, the circula- 
tion of which may be governed by* the ultimate divisions of 
one small nervous twig.” 1 
With this evident uncertainty as to the manner in which 
1 “Diseases of the Skin, a System of Cutaneous Medicine,” by Eras- 
mus Wilson, F. R. S. Sixth edition, p. 472. London, 1866. PHYSIOLOGY OF SYPHILITIC INFECTION. 
11 
simple roseolas are produced, lie does not hesitate to express 
a decided opinion that the syphilitic roseola is caused by an 
effort of Nature to expel the syphilitic poison from the system, 
and compares the syphilitic disease to the simple exanthemata. 
“ It is preceded, he says, “by a peculiar fever called the syph- 
ilitic, and bears a resemblance in its pathognomonic symptoms 
to measles, scarlet fever, and small-pox, as follows: 1. The 
nervous depression, showing the stagnating influence of the 
accumulated poison. 2. In the congestion of the mucous 
membranes, particularly that of the fauces, showing the effort 
made by the blood-vessels to eject the poison through that 
tissue; and 3. In the cutaneous exanthema which completes 
the triumph of the pressure from within, and is the sign that 
the poison is driven to the surface, and is in process of ex- 
pulsion.” There is, then, no uncertainty about the fact that 
Mr. Wilson considers syphilitic roseola the result of the pro- 
cess of the elimination of the syphilitic material through the 
skin. This view, elaborated more fully by Mr. Wilson than 
by any other writer on cutaneous or syphilitic disease, I do 
not find contradicted by any except M. Diday, of Lyons, but 
is accepted directly or through implication by all the other 
authorities I have been able to consult. Very naturally, Mr. 
Wilson does not stop at this point, but goes on to trace a con- 
nection between syphilitic roseola and the subsequent mani- 
festations of the disease. Thus, in his last “Lectures on Der- 
matology ” (published London, 1871), he says : “ Chancre, the 
focus of inlet of the poison, has run its course and healed up. 
Six weeks afterward, an exanthema, which is identical in ap- 
pearance with roseola, is developed in the skin. . . . Another six 
weeks passes by, and a second exanthema appears, no longer a 
roseola like the flrst, but an eruption of papulae, correspond- 
ing to the common lichen. Then another interval of six 
weeks transpires, and the eruption may appear for the third 
time, but with dimensions still further augmented, viz., as a 
large papula or tubercle.” In an earlier work on syphilis, he 
says: “ The transition of syphilitic roseola into lichen is so ob- 
vious that it may be observed through every stage of its prog- 
ress. A roseolous patch may be seen to develop papules . . . and 
I have furthermore seen the small papules of lichen converted 12 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
into the larger elevation called tubercle, by a sudden aggra- 
vation of the syphilitic fever, or from exposure to cold.” Of 
the simple roseola, however, he says in his last published lec- 
tures (1871), “ it is now well understood that the influence of 
the vaso-motor nerves is involved in the production of rose- 
olas.” But for the syphilitic roseola, Mr. Wilson has assumed a 
pathological importance which could not attach to it, were it 
shown to be possibly due to the impression made upon the 
sympathetic nervous system by the syphilitic influence. 
Characteristic prodromata are recognized by modern syph- 
ilographers as constantly associated with the advent of con- 
stitutional syphilis in representative cases. They are numer- 
ous and varied, as follows, viz., slight persistent increase of tem- 
perature, 99° to 101°, general malaise,, headache, rheumatoid 
pains, irregular, chiefly nocturnal, loss of appetite, indigestion, 
nausea, diarrhoea, giddiness, mental irritability, sleeplessness, 
great prostration, unnatural acceleration of breathing on slight 
exercise, the circulation generally disturbed, in some cases 
exacerbations of fever of an intermittent character, tempera- 
ture running up to 103° or 104°, followed by profuse sweats, 
etc. These are among the most prominent of the prodromata 
cited by authors, and are grouped together under the title of 
the syphilitic fever. This title is then applied not simply to 
an acceleration of the pulse, heat of skin, etc., which is usually 
understood by the term fever, but any one of the foregoing 
conditions or symptoms, or any modification or combination 
of them, is claimed to merit this title. Diday uses the more 
exact and appropriate term syphilitic prodromes. It will 
then be readily seen that, when authors speak of syphilitic 
fever as ushering in, or being associated with, syphilitic rose- 
ola, a very considerable degree of uncertainty may be claimed 
as to the dependence of such varied and common aberrations 
from the healthy state upon the development of syphilitic 
roseola. 
The connection assumed by Mr. Wilson between syphilitic 
fever and syphilitic roseola is, however, not universally ac- 
cepted. His statement that the syphilitic roseola is preceded 
(ushered in) by fever, especially with the broad interpretation 
previously given to the term, would lead us naturally to infer PHYSIOLOGY OF SYPHILITIC INFECTION. 
13 
that this was the rule. Ricord, on the contrary, says that it is 
never associated with fever, except as an accidental coinci- 
dence ; and tbat, when fever is present, it is invariably due to 
some cause quite independent of the roseola. Bassereau affirms 
that it was entirely absent in fifty-six out of the one hundred 
and ninety-nine cases critically observed by him, but it oc- 
curred in thirty-four out of fifty cases of the later papular 
eruption. Coulson states that one-third of the cases of syphi- 
litic roseola are not preceded by any premonitory symptoms. 
McCarthy (quoted by Lancereaux), that of sixty cases only 
forty were preceded by any well-marked prodromes. Of these 
forty, twenty-one had nocturnal cephalalgia alone, eleven 
cephalalgia and rheumatoid pains, and eight the latter alone; 
leaving twenty cases, or one-third, occurring absolutely without 
any premonition of any sort. Bumstead says that syphilitic 
roseola is so free from febrile excitement, heat, and pruritus, 
that the patient may not discover its presence except by acci- 
dent. 
Besides the records of observations covering a period of 
nearly two years in the Blackwell’s Island Venereal Hospital 
of this city, in 1851 and 1852, and, during the subsequent 
years, meeting frequent cases in private practice, I have called 
especial attention to this matter in every case presenting at 
my clinique in the College of Physicians and Surgeons of this 
city for the past two years, and for the last year, in the vene- 
real wards of the Strangers’ Hospital under my charge, and I 
do not hesitate now to express my entire accordance with the 
views of M. Ricord, viz., that the syphilitic roseola is never 
preceded by nor associated with any fever or other prodro- 
mata that cannot readily and reasonably be accounted for 
through causes entirely independent of the approach or the 
presence of the roseola. For the past twenty years, Mr. Wil- 
son has taught, without qualification and almost without con- 
tradiction, that syphilis, with roseola as its early exponent, 
was a distinct element; that the organism in process of infec- 
tion was gradually invaded by it, until Nature, no longer able 
to endure its presence, concentrated all its forces, at a given 
stage, to expel it, with the directness and urgency of a woman 
in labor. As he puts it in his climacteric in describing the 14 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
roseola, “completes the triumph of the pressure from within, 
and is the sign that the poison is driven to the surface, and is 
in process of expulsion” 
In the effort to understand the mysterious workings of 
syphilis in the human organism, analogical reasoning has 
naturally been resorted to ; and from the fact that there 
occurs a well-ascertained period of rest in its early develop- 
ment ; that it is associated with varied disturbances of the 
nervous and vascular systems ; and that preceding, during, or 
succeeding these disturbances, an exanthematous eruption 
occurs, it has been the fashion, for the want of a better 
place, to class it among the exanthemata, and further, inas- 
much as it has been the accepted conclusion that these dis- 
eases are the result of an effort of Nature to rid itself of the 
peccant material causing them, a like interpretation has been 
seized upon to explain the significance and value of the 
syphilitic roseola. The very important fact that, at the point 
of commencing constitutional disturbance in syphilis, the entire 
lymphatic vascular and glandular system is the subject of 
recognized and grave interference, seems to have been entirely 
lost sight of. There is nothing better understood than that, 
among the first constitutional evidences of the syphilitic in- 
fluence, an engorgement and enlargement of numerous lym- 
phatic glands remote from the point of inoculation take place, 
and that there is a marked proportional increase of the white 
corpuscular element of the blood coincident with this glandu- 
lar enlargement. Has this undoubted disturbance in a system 
of important functional use, one now recognized as occupying 
a place of acknowledged value among the hsematopoetic 
organs, no influence in producing the prodromes of constitu- 
tional syphilis ? Or must this be ignored, and all aberrations- 
from the healthy condition be attributed to the influence of a 
simple roseola which has been shown to be present and asso- 
ciated with recognized deviations from the healthy state in 
but a very limited proportion of cases ? 
Diday states it as his opinion that, in the prodromes of 
syphilis, mercurials are contraindicated, and' that iron and 
iodine will be found the best means of combating them. In 
this view, Lancereaux explicitly concurs, although he depre- PHYSIOLOGY OF SYPHILITIC INFECTION. 
15 
cates the natural inference to be drawn from such concurrence. 
“ But are we,” he1 says, “ like Diday, to conclude, from the 
fact that iron and iodine are the means to be employed for 
combating syphilitic fever, that this morbid condition has 
not the same relation to syphilis as the constitutional lesions ? 
that it is occasioned, and not directly caused, by that disease ? 
Not absolutely,” he answers, “ for, if it be permitted to attrib- 
ute to the debilitation, impressed upon the organism by the 
syphilitic poison, some of the disturbances in question, a great 
number remain which do not explain either the chlorosis or 
the anaemia.” Forced practically to acknowledge the func- 
tional disturbances as in no immediate relation to the syphi- 
litic virus, he is still unwilling to admit that the direct action 
of that virus is not in some mysterious way the local cause of 
certain of the prodromes, viz., those which cannot be made to 
connect with the immediate and perceptible blood-changes. 
That these changes, well - recognized departures from the 
healthy state of the blood, do occur, is no longer a question, 
but there is a considerable variance of opinion as to the cause 
of the disproportion of the normal constituents of the blood 
which obtains in the early stage of syphilis. Virchow claims 
that it is a leucocythemia. “ In any considerable irritation of 
a lymphatic gland,” he2 remarks, “ there is an increased for- 
mation of cells in it, and this is followed by an increase in the 
proportion of lymph-corpuscles in the blood. Billroth,3 on 
the contrary, thinks it unlikely that the hyperplasic lymphatic 
glands should be the source of an increased supply. 
“ 1. Because extensive adenopathies occur independent of 
such increase. 
“ 2. That it is very improbable that, when the normal chan- 
nels of the glands are obstructed, they should continue to per- 
form their physiological functions.” In the attempts made 
by Frey, O. Weber, and Billroth, to inject the vessels of hyper- 
plasic lymphatic glands, there was failure in every instance, 
thus affording negative proof that the enlarged glands were 
physiologically insufficient. Rindfleisch,4 however, distinctly 
1 Lancereaux, vol. i., p. 131. 2 Virchow, p. 222. 
3 Billroth, “ Surgical Pathology,” p. 209. 
* Rindfleisch, “Text-book of Pathological Histology,” p. 186, 1870. 16 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
states that lymphatic glands, the subject of aggravated hyper- 
plasia, are still readily injected. “ One is able,” he says, “ to 
fill the lymph-sinus of such glands, as well by the afferent 
vessels, as by piercing them.” 
In reports of the experiments made by Grassi, under the 
direction of M. Ricord, the disproportion found existing be- 
tween the white and the red corpuscles was claimed to have 
been caused by a diminution of the red corpuscles.1 It is now 
known that the red blood-corpuscles are regenerated at the 
expense of the white; and, with this in view, Mr. T. Henry 
Green, of London, suggests that “ conditions obtained when 
the white corpuscle already in the blood is arrested in its 
development into the red, and that possibly the white corpus- 
cles increase by multiplication in the blood.” a With this 
present disagreement of authorities as to the cause and abso- 
lute value of the leucocythemia, or chloro-ansemia, always 
associated with the real prodromes of syphilis, it may still be 
accepted as exercising a profound influence upon the nutri- 
tive and nervous functions during the period of its presence, 
which, curiously enough, coincides and passes away with the 
period of the prodromes of syphilis. 
In his elaborate and exhaustive work on diseases of the 
skin, Mr. Wilson treats of eighteen different varieties of rose- 
ola. Of these, six, viz., roseola rheumatica, roseola vaccinia, 
roseola cholerica, roseola arthritica, and roseola febris con- 
tinue, occurring exceptionally in the course of the corre- 
sponding diseases, he calls the symptomatic group of roseolas. 
“ The cause,” he says, “ may be nutritive, nervous, or assimi- 
lative.” He has already told us that the vaso-motor nerves are 
concerned in the production of roseolas, that is to say, dll 
roseolas except the roseola which occurs during the early evo- 
lution of syphilitic disease. This is claimed to be the result 
of & pathological condition, and to be but the first stage of the 
later eruptions, papular, tubercular, etc. That the papular 
eruption may be developed at a later period, and upon the 
exact spots previously occupied by the roseola, and that these 
1 Strieker, “ Human and Comparative Histology,” Sydenham Society’s 
edition, vol. i., p. 421. 
a “ Pathology and Morbid Anatomy,” Green, London, 1871, p. 132. PHYSIOLOGY OF SYPHILITIC INFECTION. 
17 
in turn, passing away, may be replaced by a still later tuber- 
cular eruption, is not only possible but almost inevitable, 
where they occur at all; but bow are we to understand this 
gradual development when we find both the papular and rose- 
olous eruptions associated together at the same time, each 
distinct and characteristic, and absolutely independent of the 
other ? This fact, which I have often seen, and have demon- 
strated in my clinique on numerous occasions, will, I doubt 
not, be confirmed by every critical observer of the early erup- 
tions of syphilis. 
Yirchow1 states that, on a section of the sympathetic nerve 
in the neck of an animal, u a state of hypersemia ensues in the 
whole of that half of the head. The ears become dark red, 
the vessels greatly dilated, the conjunctiva and nasal mucous 
membrane turgidly injected; and this,” he saysv u may con- 
tinue for days, or weeks or months without the least appre- 
ciable nutritive disturbance necessarily arising thereupon.” 
From deductions based .upon the electric experiments of 
Claude Bernard upon a bisected sympathetic, he states that, 
“ whether the relaxation of the muscular fibres of a vessel be 
produced directly by a paralysis of the nerve, or by an inter- 
ruption of the nervous influence, or whether it be the indirect 
result of a previous stimulation, giving rise to exhaustion, 
in every case, we have to deal with a kind of paralysis of 
the walls of the vessel, and that the process is incorrectly 
designated active hypercemia, inasmuch as the condition of 
the vessels in it is always a completely passive one.” 
Belladonna is well known as a relaxing agent in its effect 
upon the iris, and also in producing an eruption similar to 
the roseola of syphilis. 
Mental emotions are recognized as the cause of eruptions 
in not dissimilar cases. I have at present under observation, a 
lady upon whom an eruption, in no way to be distinguished 
from a classical, recent, syphilitic roseola, is brought out over 
the breast, back, and arms, whenever she is subjected to any 
unusual mental excitement, and which remains distinct for sev- 
eral hours, and we know that similar roseolas are initiated by 
* “ Cellular Pathology,” Virchow, p. 156. 18 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
causes that can only be referred to impressions made upon 
the sympathetic nervous system. 
But, it may be remarked, while certain of the syphilitic 
roseolas pass away in a few days, or even hours, yet, in a 
very considerable proportion, the eruption is much more per- 
sistent than in the simple roseolas, and besides, in finally pass- 
ing off, they leave a coppery stain which is considered char- 
acteristic of syphilis. 
To this it may be answered that the causes of simple rose- 
olas are transitory, and yet a thought, in the lady above re- 
ferred to, caused a rash which remained for several hours. Is 
it, then remarkable, that a cause dependent upon actual changes 
in the blood proportions and quality should be more persist- 
ent ? It is certainly the fact, and to this very persistence, 
and to it alpne, are due the pigmentary sequelae which are 
thought to be so significant. From the complete and pro- 
longed stasis of the blood in the relaxed capillaries, the hcema- 
globin (the coloring-matter of the blood) escapes through the 
vascular walls to some slight extent, and into the superim- 
posed tissue ; after a time crystallization of the hcemaglobin 
takes place, forming hcematoidin, the reddish-yellow crystals 
of which occasion the coppery stains of the skin—a result 
which may occur not alone in syphilitic roseola, but in any 
prolonged blood capillary engorgements from any cause. 
May we not, then, reasonably infer, from the foregoing, and in 
the absolute absence of proof to the contrary, that the syphi- 
litic roseola is, like the simple roseolas, the result of an impres- 
sion upon the sympathetic nervous system—a paresis of the 
vaso-motor nerves of the cutaneous envelope, caused by a 
limited but special paralyzing influence exerted upon the 
great sympathetic nerve through occult but positively recog- 
nized blood-changes ? 
We have now followed the progress of the syphilitic dis- 
ease-germ, from its original point of contact with the surface 
of inoculation, to its lodgment in the second order of lym- 
phatic glands. If the foregoing view of the nature of the roseola 
of syphilis be accepted, we have no positive evidence that the 
disease has yet reached the blood. Delayed for a limited pe- 
riod at the point of inoculation by unavoidable physical and PHYSIOLOGY OF SYPHILITIC INFECTION. 
19 
physiological obstructions, it finally reaches the first order of 
glands (the glands of connection); delayed here again for an- 
other period by the same causes that obtained in the first 
instance, it finally passes on through the afferent lymphatic 
canals to and into the second order of glands, which become 
involved in precisely the same manner as the first. Thus, if 
we are willing to accept the view of Diday, that the prodromes 
of syphilis are due to the chloro-ansemia, the sole evidence of 
the presence of the so-called syphilitic virus is still to be found 
in the lymphatic system. We have, it is true, at about 
this time, in a considerable proportion of cases, an inflamma- 
tory engorgement, more or less intense, occupying the mucous 
membranes of the pharynx and tonsils ; but the tonsils have 
been recently accepted as belonging to the lymphatic system, 
representing a simple form of lymphatic gland, although no 
direct communication has yet been demonstrated between the 
follicles composing the tonsil and the adjacent lymphatic 
vessels; these cover them in almost completely, and they are 
besides so dilated that they are rather lymph-sacs or lacunae 
surrounding the follicle. 
The entire pharynx is much richer in lymphatics than the 
surrounding mucous membrane. At this point, then, we 
should expect, with the general engorgement of the lymphatic 
system, early evidence of disturbance. Brought here into 
more intimate relations with the blood vascular system than 
occurs in lymph-glands of a higher order, the implication of 
these lymphatic accessories is often followed by a true inflam- 
matory engorgement, which not unfrequently results in a 
rapid gangrenous or ulcerative destruction of tissue. 
In the necessarily frequent allusion to different authorities, 
as the subject of syphilis is considered, the term virus con- 
stantly occurs; it is, therefore, perhaps not out of place here 
to repeat that, according to the views advanced in this and in 
the preceding paper, it is not a virus which is accepted as 
producing syphilis, but an abnormally active natural ger- 
minal cell or corpuscle, that, being introduced into a healthy 
organism, impresses the normal germinal molecules with an 
action similar to its own ; that the nutritive changes and de- 
viations from health in syphilis are simply the result of a too 20 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
rapid development of such germinal material as the hyper- 
active corpuscle may have been able to impress with its influ- 
ence ; that in no case is the disease-germ or its descendants 
able to arrive at any maturity; that they never become ele- 
vated into red blood-corpuscles, nor ever form a permanent 
ingredient in any useful tissue; that, as certain conditions 
of vascular excitement, which we call inflammatory, hasten 
the development of the white blood-corpuscle, up to the 
point of emasculation, resulting in the pus-corpuscle, so a 
more subtle influence imparts to certain of the white blood- 
cells a greater tenacity of life and a capacity of somewhat 
higher development; capable of a certain low power of or- 
ganization, but still falling short of the ability to combine with 
the normal tissues, in any way, except as foreign material, 
to embarrass and disturb their normal development and func- 
tional integrity. 
The vitiated corpuscles, then, holding on their course 
through the lymphatic system in which we have observed 
them repeatedly, and for a time effectively, arrested by glan- 
dular barriers, finally gain an entrance into the general cir- 
culation. 
It is by no means improbable that the lymphatic glands 
act as depots, as claimed by Yirchow, and that, in occasional 
cases, the vitiated corpuscles are retained in these organs, 
until a normal or artificially excited fatty degeneration has 
enabled them to be partially or wholly eliminated from the 
system. In this way, the occurrence of cases of syphilis pre- 
senting marked deviations from the usual course of the dis- 
ease may be accounted for. In classical cases, however, there 
seems to be no reason to doubt but that the vitiated ger- 
minal material passes into the blood along with the normal 
lymphatic elements. 
The earliest evidence that this occurrence has taken place 
appears in the very great majority of cases in the develop- 
ment of a papular eruption—symmetrical and more or less 
general—and usually preceded by or ushered in with an in- 
crease of temperature, an acceleration of the pulse, and vari- 
able degrees of nervous and functional disturbance. This 
eruption is usually composed more or less from distinct eleva- PHYSIOLOGY OF SYPHILITIC INFECTION. 
21 
tions of the skin, varying in different cases from the size of 
a pin’s-head to half a dime, or even larger. Mr. Wilson, con- 
sistently with his teaching in regard to the syphilitic roseola, 
remarks that “ when the eruptive force is sufficiently power- 
ful, the case is one of lichen.1 In this form there sometimes 
appears a tendency to aggregation into small groups or clus- 
ters ; this is known as the lichen corymbosus. Other varieties 
present, dependent upon size or arrangement, as the lenticu- 
lar, the papular, the annular, as described by different au- 
thors. The seat of origin of these papular eruptions appears 
to be still in dispute. Zeissl thinks that the sebaceous or 
the hair-follicles are the principal seat. Mr. Wilson, in de- 
scribing a case of the lichenoid form observed by him, says : 
“ The aperture of a follicle was apparent at the summit of 
each papule, marking the seat of the inflammatory congestion 
to be the capillary plexus of the follicle.” Lancereaux be- 
lieves that the papillae of the dermis are also sometimes the 
starting-point of this affection. Rindfleisch says of the simple 
papulous exanthemata that “ the exudation is seated in the 
papilla itself.” According to Mr. Tilbury Fox, “ the true 
papule is due to a plastic exudation into the skin, especially 
of the papillary layer.” Possibly it can be shown that the 
origin of the papule is always, and of necessity, in the papillae 
cutis. 
u The blood,” says Rindfleisch, “ is the medium of ex- 
change of the material of the organism. It is the nutritive 
fluid which conveys to each individual portion of the body 
the nutritive ingredients necessary for its existence, and in- 
stead, carries away from the parts the useless and injurious 
products of the chemical processes associated with nutri- 
tion.”3 This circulating medium is carried out, from the 
centre of the circulation to the periphery, by the arteries and 
returned by the veins. Intercalated between these two sets 
of vessels is the lymphatic system, which withdraws from the 
tissues such nutritive materials as are exuded in excess by the 
arteries into the tissues, and returns them again into the cir- 
1 Wilson on “ Diseases of the Skin,” 1866, p. 474. 
8 Ripnfleisch, p. 181. 22 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
dilation at a given point. Now at the nearest points of con- 
tact of these systems of vessels, at the superficies of the body, 
we should expect to find collections of surplus material, which, 
after having escaped from the arteries, were unable from any 
cause to effect an entrance into the under-drainage vessels, 
the lymphatics. The relation of these vessels in the cutane- 
ous envelop, as described by Teicliman, is as follows: “ The 
blood-vessels lie around the circumference of the papillae 1 
(winding up, corkscrew fashion, around the papilla ifhtil they 
unite at its apex); while the lymphatic vessels lie exactly in 
the centre of the papillae, and no lymphatics are found in the 
sebaceous follicles, the sweat-glands, or the hair-bulbs. Con- 
sequently, it is in this juxtaposition of the blood-capillaries 
surrounding the papillae, and the lymphatic capillaries pass- 
ing up through their centres, that is to say, in the interval be- 
tween these, that we should expect to find materials escaped 
from the blood-capillaries, detained in their transit into the 
lymphatic capillaries. At this point, the force of the circula- 
tion is at the minimum, the condition most favorable for pro- 
liferation. The act of proliferation is a vital one, one predis- 
posing to the coagulation of the fibrine contained in the 
tissue-fluid. 
With these predisposing forces and conditions, it is natural 
to expect an accumulation of cell-material and .a separation 
of the fibrine of the lymph, and these resulting in a hyper- 
plasia of the papillary layer of the cutis. This, too, most 
prominent, in the interval between the blood-capillaries dis- 
tributed around the summit of the papilla and the lymph- 
capillary which passes up through its centre, necessarily giv- 
ing rise to the abnormal elevations termed syphilitic papules. 
T'hese papules vary in size, as the hyperplasic papillae are 
more or less abundant—appearing in lichen as quite dis- 
crete, while in the larger varieties an aggregation of papillae 
occurs, and is consolidated through the escape of the hyper- 
plasic materials into the adjacent surrounding tissue. We 
are thus enabled to account for the variations in the size of 
papules, occurring as a result of the proliferation of cell-ele- 
ments in the papillary layer of the cutis. 
1 Rindfleisch, p. 277. PHYSIOLOGY OF SYPHILITIC INFECTION. 
23 
The recent observations of Kohn, 1870/ in regard to the 
histological constituents concerned in the formation of the 
papular syphilides, confirm the foregoing views : “ They are 
formed,” he says, “ uniform and dense, limited clearly by in- 
filtrations into the papillae and corium. These infiltrations 
are constituted by an accumulation of cells, which are piled 
up in dense and regular layer, around the vessels in the in- 
terstices of the connective tissue. The cells are not destined 
to be permanently organized, as they degenerate and disap- 
pear, or assume a dull granular appearance, undergo fatty 
degeneration and are absorbed, or they may become heaped 
together in. the form of detritus and form pus. Upon the 
section of a papule, it is seen that it is limited by two lines 
formed of cells which are accumulated in the corium and on a 
level with the papillae. The latter two structures are glued 
together, while the epidermis is stretched. The papule is re- 
sistant, in consequence of the accumulation of the cell-ele- 
ments, and its color is due to the capillary stasis, to any effu- 
sion of the coloring-matter, and perhaps to the color of the 
new formation.” These observations of Dr. Kohn are in 
complete accord with the previous statements made by 
Auspitz/ Yirchow/ Neumann/ and Taylor.6 
The syphilitic papule, then, whether occurring as a local 
or a general eruption, may be considered as the result of a 
proliferation of the cell-element, and an organization of the 
fibrine, separated from the tissue-fluid, and which has usually, 
if not always, a papilla cutis as its seat of origin. Here we find 
the point of nearest circumscribed contact or closest relation, 
viz., betw.een the blood-capillaries and the intercalated lymph- 
vessel of the papilla, and not in the sebaceous follicle, or in 
1 “ Caract&res cliniques et histologiques des Syphilides,” par Moritz 
Kohn. Wiener Med. Wochenschrift, 1870, No. 55. Archives G6nerales 
de M6decine, March, 1872. 
1 Auspitz, “ Ueber die Zellen Infiltration der Leiderhaut,” Medizin- 
ische Jahrbucher, vol. ii., p. 208, 1864. 
s Virchow, “Pathologie des Tumeurs.” Trad. Franc., vol. ii., p. 361, 
et seq. 
4 Neumann, “Lehrbuch der Hautkrankheiten,” p. 240. 
6 Taylor, “Observations on the Papular Syphilides.” American Jour- 
Of Syphilography and Dermatology, April, 1870, p. 108. 24 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
the hair-bulbs, or in the sweat-glands, with which lymphatic 
vessels have not been found to be so associated. In regard, 
therefore, to these latter, we are led to conclude that when 
they are apparently engaged in the formation of a syphilitic 
papule, it is only by their being aggregated into the papule 
by the exudation of cell-material which has originated within 
the papilla cutis. It is not now, perhaps, too much to assert 
that the syphilitic papule is always an evidence of an abnor- 
mal proliferation, excited by the influence of the syphilitic 
disease-germ, or corpuscle which has escaped from a blood 
capillary in a papilla cutis, and occurs separately or in groups, 
the arrangement differing in different cases, from influences 
not yet determined. 
We have, besides the well-marked papular syphilide, pus- 
tular and vesicular eruptions associated with the early period 
of syphilis, and from the manner in which the papular syphi- 
lide has been claimed to originate, it is easy to understand 
why the pustular and vesicular forms of eruption, occurring 
at a similar period in the progress of the disease, often mingled 
with and visibly originating from the syphilitic papule, should 
be considered simply as abortive papular syphilides. Kohn, 
it will be remembered, remarks of the syphilitic papule, that 
“ the cells composing it are not destined to be permanently 
organized, as they degenerate and disappear, undergo fatty 
degeneration, and are absorbed, or are heaped together as 
detritus, and form pus.” 
The pustular and vesicular syphilitic eruptions, then, 
would seem to result from a lack of formative power in the 
lymph, and from the inability to form, or the easy liquefac- 
tion of, the hyperplasic materials, this occurring probably from 
a low state of the system, produced either by general causes 
or by some especial dyscrasia, not necessarily dependent upon 
the syphilitic influence. 
Prominent among the manifestations of early constitu- 
tional syphilis is the mucous patch. This consists of an 
erosion of the surface or a complete destruction of mucous 
membrane upon which this peculiar lesion is always situated. 
The erosion or entire disintegration of the mucous membrane 
is followed by the exudation of lymph from the denuded PHYSIOLOGY OF SYPHILITIC INFECTION. 
25 
surface and its rapid organization, thus producing a white 
fibrinous pellicle which is a constant accompaniment of this 
lesion. 
Virchow 1 says of hyperinoses: “ I do not think that we 
are enabled to conclude that, in a person who has an excess 
of fibrine in his blood, there is, on that account, also a greater 
tendency to fibrinous transudation, on the contrary, I should 
rather expect that, in a patient who produces at a certain 
point a large quantity of fibrine-forming substance, much of it 
would pass from that point into the lymph and finally into 
the blood. The exudation, therefore, in such cases, may be 
regarded as the surplus of fibrine formed in loco, for the re- 
moval of which the lymphatic circulation did not suffice. In 
accordance with this view, then, the mucous patch may be 
considered the accidental focus of development of the syphi- 
litic corpuscle, resulting from superficial lymphatic capillary 
obstruction caused through a hyperplasia excited by the 
presence and usual influence of the syphilitic disease-germs. 
Mucous patches always occur upon mucous membranes richly 
endowed with lymphatic vessels, as upon the soft palate, the 
tonsils, the gums, the inner surfaces of the cheeks, the tongue, 
the walls of the pharynx, etc. 
The mucous tubercle, which is the analogue of the mucous 
patch, occurs upon the integument at points also of unusually 
abundant lymphatic distribution, as about the vulva, the anus, 
on the scrotum, about the nails of the fingers and toes, etc. 
A specific exudative inflammation of the eye is a not 
infrequent occurrence in early constitutional syphilis. The 
late Prof. Von Graefe made the statement that, according to 
statistics collected by him, about sixty per cent, of all cases of 
iritis occur in persons affected with syphilis. Dr. Bumstead 3 
says : “We have no certain means of distinguishing syphilitic 
iritis from that dependent upon injury, rheumatism, or other 
causes,” and thus describes the pathological changes which 
occur in the course of this affection in syphilis : 
“ At an early stage of the disease, the pupil assumes a dull 
appearance, owing to commencing changes in the anterior 
1 “ Cellular Pathology,” p. 199. 
•Bumstead on “Venereal Diseases,” third edition, p. 660, 1870. 26 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
capsule of the lens; it may also be somewhat irregular. This 
irregularity of outline due to adhesion between its margins and 
the capsule of the lens, or to exudation into its substance, be- 
comes more marked as the disease progresses, and is especially 
evident if the pupil be dilated by belladonna or atropine. 
When its margin is found to be scolloped, owing to its being 
attached at some points and drawn out in others, in some 
cases the adhesions become continuous around the whole cir- 
cumference, and the capsule of the lens is covered with a 
layer of lymph which completely blocks up the pupil.” 
This inflammation may be serous instead of plastic, or it 
may assume a suppurative form. It is associated with the 
period of roseolous or papular eruptions, mucous patches, etc. 
Carmichael states that the eruption usually associated with it 
is the papular. 
Recent observations have shown the presence of an exten- 
sive distribution of lymphatic vessels in every structure and 
tissue in the human organism. Everywhere that blood-vessels 
are present, an accompanying system of lymph-vessels is 
also found, thus going far to conflrm the recent views of 
Willis, Recklinghausen, and others, of the office of the lym- 
phatic system as a necessary adjunct to the blood vascular sys- 
tem, for the purpose of gathering in and returning to the 
general circulation the excess of lymph exuded for purposes 
of nutrition. With this view of the office of the lymphatic 
system, it is easy to account for many diseased conditions 
heretofore considered anomalous, to appreciate the causes of 
the multiform lesions in syphilis which have hitherto puzzled 
acute clinical observers, and conveyed to them the impression 
that the disease was developed through no fixed laws, but re- 
sulted from a general and almost necessarily permanent vitia- 
tion of the entire affected organism. 
The structures of the eye, especially the more delicate, as 
the iris, the retina, the conjunctiva, etc., have hitherto been 
considered as entirely deficient in a lymphatic circulation. 
Schwalbe1 has, nevertheless, fully demonstrated their presence 
1 “Handbuch der Lebre von den Geweben der Menscben und der 
Thiere,” by Strieker, Leipsic, 1872. PHYSIOLOGY OF SYPHILITIC INFECTION. 
27 
in all these structures, and has shown an especially generous 
distribution to the iris, and in excess of the neighboring tis- 
sues. With the presence of the vitiated germinal element 
free in the general circulation, with its known power to cause 
obstruction to the lymph circulation, and a consequent hyper- 
plasia, what should we expect to find ? As a natural sequence, 
we should expect what we find in the advance and course of 
syphilitic disease, viz., that this delicate structure often sulfers, 
and through the same causes that result in hyperplasias, in 
other parts richly endowed with lymphatic vessels. 
A very general impression prevails that there is an entire 
absence of the lymphatic distribution in the osseous struct- 
ures. Cruikshank, many years since, claimed to have dis- 
covered the entrance of a lymph-vessel into a dorsal vertebra. 
More recently, this observation has been confirmed by Soem- 
mering and Bonamy. Sappey and Gross have demonstrated 
the presence of lymphatic vessels in the marrow of the tibia. 
Bonamy states that he injected the lymphatics which arise 
from bones by little foramina which are found on the side of 
the internal condyle of the femur. Accepting these state- 
ments, we find a reasonable explanation of the occurrence of 
ostitis and periostitis, and the formation of nodes, which are 
found associated with the early or active period of syphilis. 
Not alone in the structures of the eye, and in the bones, in 
the Ui.iscles, and in the serous membranes generally conceded 
to be outside the track of the lymphatic distribution, are these 
essential vessels now ascertained to be present. Even in the 
fibrous and cartilaginous tissues—those most scantily supplied 
with blood-vessels of all the normal structures—these vessels 
have been absolutely demonstrated. The recent work of 
Ludwig and Schweigger-Seidel, published in Leipsic, 1872, is 
rich in illustrations of the presence and distribution of lymph- 
vessels in cartilages and fasciae. Through the kindness of 
the President of this Society, Dr. Jacobi, I am now able to 
exhibit to you this very admirable and elaborate work, re- 
ceived during the last month from Leipsic. 
Time does not, at present, allow me to extend the consid- 
eration of the subject of Hie evening further, but on a future 
occasion I confidently expect to be able to demonstrate the 28 
PHYSIOLOGY OF SYPHILITIC INFECTION. 
intimation conveyed to you at the close of my previous paper 
on syphilitic infection, viz., that many if not all of the later 
manifestations of syphilis may be satisfactorily explained 
through causes wholly dependent upon interference with the 
lymphatic circulation, and that it is to deposits of fibrine, or- 
ganized through the syphilitic influence, in and around lymph- 
vessels and lymph-sacs, in the earlier stages of the disease, 
and its subsequent contraction, that the various external and 
internal lesions occurring in the later stages of syphilis are 
chiefly due. 
And, still further, I believe that the management of this 
disease is capable of being established upon an intelligent 
and philosophical basis; not necessarily changing the present 
recognized methods of treatment, but by affording a reason- 
able explanation of the manner in which known, effective, 
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